The long-term goal of this research is to help pediatric cancer patients cope with distress and anxiety caused by their illness and its treatment. This is consistent with the National Cancer Institute's goal of improving cancer care. Animal-assisted activities (AAA), such as visiting pet programs, may reduce distress and help children cope in medical settings. They may be especially beneficial to pediatric cancer patients who undergo serious, lengthy, and often painful treatments. Because the safety and effectiveness of such interventions for this population is unknown, they must be investigated through rigorous randomized controlled trials (RCTs). Designing RCTs of AAA in pediatric oncology requires understanding the barriers and opportunities unique to these settings and patients. Our objective is to determine how to design a RCT of AAA in pediatric cancer patients. We will: 1) identify barriers to and facilitators of AAA in inpatient and outpatient pediatric oncology settings through interviews and focus groups of clinical staff, and surveys of patients and parents; 2) identify AAA interventions that would be feasible in pediatric oncology settings; and 3) design and pilot test an AAA intervention in pediatric oncology in preparation for a larger RCT. Two large regional pediatric cancer centers in the Pacific Northwest (Seattle Children's Hospital and Oregon Health and Science University) will participate. Four focus groups with oncology staff and approximately 20 individual interviews with selected leaders in relevant departments and programs (e.g., oncology, infection control, risk management, child life, behavioral health) will be conducted, audio-taped, and transcribed in the first year of the study. Qualitative content analysis of these transcripts will identify important themes related to both implementing and evaluating AAA in pediatric oncology settings. In addition, surveys of approximately 80 patients (aged 8-18) and 130 parents will provide additional information on barriers and opportunities for future interventions and research. In the second year, we will design and pilot a small intervention with approximately 10 patients based on our results from the first year. The results from this feasibility study will inform the design and implementation o a future large-scale RCT on the effectiveness of AAA to reduce distress in pediatric and adolescent oncology. If safe and effective, AAA interventions could provide a low-cost way of improving quality of care and of life for a particularly vulnerable population of cancer patients and their families.